Department of General Practice
Julius Center for Health Sciences and Primary Care
University Medical Center Utrecht
Placement: Brigham and Women’s Hospital
Mentor: David W. Bates, M.D. (Chief, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital and the Harvard School of Public Health)
Co-Mentor: Jeffrey Schnipper, M.D. (Associate Physician, Department of Medicine, Brigham and Women’s Hospital)
Project Title: Connecting Two Worlds: How Care Transition Interventions Work in the Different Contexts of Primary and Secondary Care
Dorien Zwart, M.D., Ph.D., is a 2016-17 Dutch Harkness Fellow in Health Care Policy and Practice. Zwart is currently an associate professor in the Department of General Practice in the Julius Center for Health Sciences and Primary Care at University Medical Center Utrecht. She also practices as a Family Physician at the Primary Health Care Center De Bilt. She primarily focuses on patient safety in general practice, and within this scope, is developing and supervising a research portfolio on patient safety in primary care, as part of healthcare innovation research in Julius Center of Health Science and Primary Care. This portfolio includes projects on the Transitional Incident Prevention Program, which centers on safety in patient transitions between primary and secondary care, a trial on pharmacotherapy optimization through integration of a non-dispensing pharmacist in a primary care team, and a study aiming at analysis and improvement of telephonic triage of patients with complaints that are suspect for acute cardiovascular disease (Safety First). Beside her research on patient safety, she co-supervises the academic medical education research within her department, where she is responsible for innovation and development for the master’s program. Zwart received her medical degree from the University of Groningen, her medical specialty degree from the University Medical Center Utrecht, and her doctorate from the Graduate school of Life Sciences at the University of Utrecht.
A safe patient journey between hospital and home requires comprehensive processes, adequate communication and teamwork between secondary and primary care - conditions that appear inherently difficult to achieve. Many care transition interventions have been studied or implemented, and yet the fidelity of the interventions and their outcomes remain sub-optimal. One explanation for the persistence of safety issues in transitions may be that the differences in contexts structurally cause disconnects between primary and secondary care. Understanding how care transition interventions work from a theoretical perspective may help in interpreting outcomes refining interventions. This project aims to develop a theory map that describes the active elements of care transition interventions and the causal mechanisms involved. The mixed methods study will include document review and interviews with researchers, experts and clinicians about their experiences with interventions that aim to improve patient transitions between hospital and home, and vice versa, throughout the US. Hypotheses will then be formulated based on the theory map and tested on care transition intervention practices at Partners Health Care. Frontline, organization, and health policy implications for care transitions between hospital and home in different systems will be further explored through interviews and focus groups.